Diabetic Ketoacidosis (DKA)
(Last Updated - 11/21/2006)
-characterized by a high Anion Gap initially which normalizes w/ treatment
-Treatment:
1) IVF's:
-Usual deficit --> 6-8 L
-NS 1L over 1st hour then 300-500 mL/hr over next 12 hrs
-Then 200-300 mL/hr w/ 1/2-NS until glucose < 300 then switch to D5W to prevent hypoglycemia
2) Insulin:
-Initial loading dose of 0.15-0.2 units/kg of Regular then 0.1 units/kg/hr
-Monitor serum glucose QHr for 1st 2 hrs then Q2-4 hrs
-Goal: Drop serum glucose by 80 mg/dl/hr --> if not reaching then double Insulin gtt
-When serum glucose is ~250 --> decrease Insulin gtt to 1-2 units/hr and continue until adequate fluid replacement achieved (HCo3- normal & ketones normal)
-30-60 mins prior to stopping Insulin gtt give a SQ dose of Regular (due to IV Regular's short 1/2-life)
-When able to eat --> NPH 10-15 units QAM & RISS
3) Electrolytes:
A) Potassium (K+):
-Total K+ loss is 300-500 mEq
-As long as there is no EKG evidence of hyperkalemia:
1) Peaked T-waves
2) Decreased or absent P-waves
3) Shortened QT intervals
4) Widened QRS complexes
B) Phosphate:
-If serum Phos < 1.5 mEq/L then give 2.5 mg/kg IV of elemental Phos over 6 hrs
-Must check Ca2+ prior to Phos admin --> IV Phos can cause hypocalcemia
C) Magnesium (Mg2+):
-Only given for significant hypomagnesemia or refractory hypokalemia
4) Bicarbonate (HCo3-):
-ONLY for pH < 7.0 b/c may worsen hypokalemia, intracellular acidosis & cerebral edema
-Give 44-88 mEq of Na-HCo3 in 1 L of 1/2-NS Q2-4 hrs until the pH > 7.0
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